Distractions in the operating room can contribute to errors. Based on survey responses from 160 healthcare workers, this study examined perceived distractions in the operating room. All participants ranked auditory distractions as the most distracting and visual distractions as the least distracting, but the top five distractors fell into the equipment and environmental categories – (excessive heat/cold, team member unavailability, poor ergonomics, equipment unavailability, and competitive demand for equipment). Phone calls/pagers/beepers were also cited as a common distractor. 

Surgical fires, though uncommon, can result in serious harm. This review highlights three components to be managed in the operating room to prevent fires: an oxidizer, an ignition source, and a fuel. The authors provide recommendations to ensure each element is handled safely.

Operating rooms are high-risk work environments. Improper use of energy-based surgical devices can increase risks of surgical fires. This commentary describes an initiative to address this safety concern by educating physicians and staff who work in the operating room environment about how to safely use the equipment. A past WebM&M commentary discussed operating room fires and how to prevent them.

This systematic review found that equipment and procedural distractions were the most severe distraction events during surgery, but irrelevant conversation and movement were the most frequent. This underscores the need to reduce distractions and incorporate management of distractions into surgical education.

Surgical fires, though rare, can be particularly serious. This commentary analyzes factors that increase risks of these incidents, such as the presence of volatile substances in the operating room, use of highly-specialized technologies, and insufficient clinician experience with equipment.

Written consent forms often introduce issues related to legibility and completeness. A Web-based system for booking elective surgical procedures improved the rate of obtaining and documenting informed consent in a community hospital system.

Simulation training for operating room (OR) teams is an effective tool for improving teamwork and communication, but can be resource intensive and expensive. Due to these barriers, most simulation programs have only included trainees. For this study, a malpractice insurer provided the financial and administrative resources necessary to develop a standardized OR simulation training curriculum that involved active participation of attending surgeons and anesthesiologists. The group provided modest compensation for physicians' time and achieved wide participation. This teamwork curriculum covered principles of communication, assertiveness, and use of the WHO surgical safety checklist. Nearly all (93%) participants thought that the training would help them provide safer care. Dr. David Gaba discussed simulation training in a recent AHRQ WebM&M interview.

… validated to ensure their effectiveness. … Brindley PG, Jones DB, Grantcharov T, de Gara C. Can J Surg. …

The majority of practicing surgeons surveyed in this study were unaware of risk factors and preventive methods for surgical fires.

This study compared the performance of surgeons younger and older than 55 in a simulated operative setting to demonstrate that age in itself is an arbitrary predictor of skill assessment. The authors advocate for simulation as a potential tool to evaluate performance in the context of re-credentialing.

In this study of simulated cholecystectomies, surgical residents felt ill-trained to disclose both complications (common bile duct injury) and serious incidental findings (gallbladder cancer) encountered during a cholecystectomy. Most concerning, a large proportion of residents did not adequately describe potential complications when obtaining informed consent.

A multidisciplinary simulation, using a high-fidelity surgical simulator, was used to assess performance of experts and novices in dealing with a technical mishap.

The authors introduce a number of surgical simulation methods and discuss how training curricula should evolve to best incorporate simulation technology.